Provider Demographics
NPI:1457460131
Name:MONTANO RIVERA, LOURDES (MD)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:MONTANO RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142427
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2427
Mailing Address - Country:US
Mailing Address - Phone:787-878-5746
Mailing Address - Fax:787-878-5746
Practice Address - Street 1:AVE BARBOSA #66
Practice Address - Street 2:ARECIBO MEDICAL PLAZA SUITE 202
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-878-5746
Practice Address - Fax:787-878-5746
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10081208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88657Medicare UPIN